Reye Syndrome

Reye syndrome, an extremely rare but serious illness that can affect the brain and liver, occurs most commonly in kids recovering from a viral infection.

Named after Australian pathologist R. Douglas Reye, who first reported it as a distinct syndrome in 1963, Reye syndrome is still not well understood. Studies have linked the use of aspirin (also called salicylates) or aspirin-containing medications during viral disease as a factor in the development of Reye syndrome.

Cases have dropped dramatically since this link was discovered and doctors started advising against giving aspirin to kids and teens, especially during viral illnesses.

About Reye Syndrome

Reye syndrome predominantly affects kids between 4 and 14 years old, and occurs most frequently when viral diseases are epidemic, such as during the winter months or following an outbreak of chickenpox or influenza B.

Duration varies with the severity of the disease, which can range from mild and self-limiting to, rarely, death within hours. Although severity varies, Reye syndrome is a potentially life-threatening disorder that should be treated as a medical emergency.

Early detection and treatment are critical — the chances for a successful recovery are greater when Reye syndrome is treated in its earliest stages.

Signs and Symptoms

The signs and symptoms of Reye syndrome are almost always preceded by a viral illness, such as an upper respiratory tract infection (a cold, the flu, etc.), a diarrheal illness, or chickenpox. Many cases are mild and may even go undetected; others can be severe, requiring aggressive care.

Reye syndrome can occur from 1 day to 2 weeks after a viral infection. The viral illnesses that lead to it are contagious, but the syndrome itself is not.

Symptoms include:

frequent vomiting

lethargy or sleepiness

in infants, diarrhea and rapid breathing

irritability or aggressive behavior

In the later stages, a child may exhibit irrational behavior, confusion, severe muscle weakness, seizures, and loss of consciousness. There is usually no fever.

Other symptoms include changes in vision, difficulty hearing, and abnormal speech.

Reye syndrome is now very rare: only a few cases a year are reported in the United States. It should be considered, however, in a child with frequent vomiting or a change in mental status or behavior — particularly if this occurs after a recent viral illness.

Prevention

Aspirin and other drugs from the salicylate family should never be used in the treatment of chickenpox, influenza, and other viral diseases. Many over-the-counter (OTC) medications contain salicylates, so be sure to read the labels and talk to your health care provider if you’re not sure whether a medication is safe for your child.

In general, aspirin (salicylates) should not be used for kids or teenagers except on the advice of a doctor for certain conditions.

Treatment

Children with Reye syndrome are usually treated in a hospital; those who are seriously ill will be cared for in the intensive care unit (ICU).

Treatment is supportive as there is no cure. The clinical care team focuses on making sure a child with Reye syndrome stays hydrated and maintains electrolyte balance, and monitors nutrition intake and cardiorespiratory status. Chances of recovery are greatest when these key systems are as balanced as possible. Tests that might be done include blood tests to monitor electrolytes and liver function and an imaging study of the brain (CAT scan or MRI).

Mechanical ventilation (a breathing machine or respirator) can be necessary if breathing becomes too slow or ineffective. Intracranial pressure (pressure of the fluid within the brain) and blood pressure might be monitored. Small quantities of insulin may be given to increase glucose metabolism, corticosteroids to reduce brain swelling, and diuretics to get rid of excess fluid. If seizures occur, they are treated with medications.

The prognosis for children with Reye syndrome has improved. Thanks to earlier diagnosis and better treatment, the survival rate has risen to about 80%. The earlier the syndrome is detected, the better the chances for survival. Children who progress to the late stages of the syndrome may suffer brain damage and disability.

When to Call the Doctor

If your child has vomiting, behavioral changes, or extreme sleepiness, especially after a viral illness such as the flu or a cold, contact your doctor or get medical help right away.

Of course, many kids with viruses will have some of these symptoms, and most will not have Reye syndrome. Nevertheless, early detection is the key to successful treatment of Reye syndrome.